On a hot day in July, Aparna Bole, M.D., a Cleveland pediatrician, got an urgent call about a patient.
A 9-year-old girl she was treating for obesity was in trouble. While attending summer camp, the girl experienced dizziness and nausea, done in by the temperatures that peaked at over 100 degrees each day during the prolonged heatwave.
Bole, who had been pleased the girl was staying active over the summer, reminded her young patient during an office visit that she must stay hydrated, stay out of the sun at the peak of the day and wear light clothing. After a day off, the girl returned to camp with no long-lasting effects from both dehydration and heat exhaustion.
Bole attributed what happened to the ever-increasing effects of climate change on her patients. It’s why she is the incoming chair of the American Academy of Pediatrics Council on Environmental Health.
The nonprofit is a professional association of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of infants, children, adolescents, and young adults. “When I say that I’m a pediatrician, people are often surprised to learn about my work in environmental health and climate. But climate change is a public health issue that disproportionately affects children,” she said in an interview with FierceHealthcare.
Last June, when more than 70 medical and public health organizations called for U.S. leaders to combat climate change, which the groups called a “health emergency,” Bole’s voice was among those speaking out. “Climate change is one of the greatest threats to health America has ever faced—it is a true public health emergency,” the groups wrote (PDF).
Extreme heat is among the deadliest weather hazards society faces, according to a report released by the Union of Concerned Scientists in July (PDF). During extremely hot days, it said, heat-related deaths spike and hospital admissions for heat-related illnesses rise, especially among the most vulnerable groups.
It's important to take into account regional differences when it comes to responding to heat, said Emilie Mazzacurati, the CEO of climate data company Four Twenty Seven. The company worked with California Department of Public Health officials and healthcare organizations to identify which temperatures triggered surges in emergency department visits.
For instance, providers need to know that the threshold for a heatwave in San Francisco is closer to 80 degrees, while in the Central Valley—where it’s much hotter all year round—a heatwave might be triggered once it hits 100 degrees, she said.
Climate change is already affecting the health of the children she cares for by affecting air quality and causing increasingly frequent extreme rain and heat events, such as those that smothered the country in that July heatwave, Bole said.
Worsening air quality linked to global warming is increasing the risks faced by her patients, as one in five children in Cleveland has asthma, compared to one in 10 nationally. While it’s good for kids' health to be active and play outside, Bole has to remind children and parents to check for air quality advisory days and avoid being outside on those days when the quality is poor and their asthma can become worse.
It’s not just kids at risk. Across the country in Boston, Mary Rice, M.D., a pulmonologist at Beth Israel Deaconess Medical Center, was about to leave the clinic for the day to visit a patient in the hospital. The heat that did in Bole’s young patient landed a female patient who suffers from severe COPD in the hospital. She was treated for dehydration and shortness of breath that was triggered by the heatwave, Rice said.
Rice said COPD, a progressive lung disease, can be exacerbated by heat and humidity. She advises her patients with COPD to stay inside on very hot days. Hotter summers are linked to climate change, with consequences on human health, she said.
"In the field of medicine, we need to act on the best data that we have. In the case of climate change, the evidence is clear that temperatures are warming and it's due to human emissions of carbon dioxide. It's also clear that climate change is hurting human health," said Rice, who is an assistant professor of medicine at Harvard Medical School.
The consequences go beyond respiratory issues in patients. Regina LaRocque, M.D., an infectious disease specialist at Massachusetts General Hospital in Boston and an assistant professor of medicine at Harvard Medical School, cites statistics from the Centers for Disease Control and Prevention that show tick-borne illnesses have more than doubled in 13 years. “We are seeing the impact of climate in our everyday work,” she said.
The CDC said from 2004 to 2016, nine vector-borne human diseases were reported for the first time in the United States and U.S. territories. In New England, doctors are seeing new tick-borne diseases, such as Powassan virus.
“We’ve seen almost a dozen cases, some of them treated right here at Mass General. The bottom line is we are seeing things affecting our patients,” said LaRocque, who also serves on her town’s Natural Resources Commission after running for the office more than two years ago.
For Bole, it’s connecting the dots. She hopes physicians talking about climate change will make people realize that it isn’t just far-off creatures such as polar bears that face the threat of environmental change. “The health message helps underscore the fact that climate change is a problem that is taking place right now to our species—human beings—right here in our backyard. And that's a fact,” she said.
But with more doctors speaking out, both Bole and LaRocque say they are hopeful leaders will take steps to address climate change.
“I feel a great deal of optimism right now because we know we have such a critical window to act on climate. We are in it right now,” Bole said. “I think there's a real sense of urgency that this is our time to act.”
Charts contributed by Data Editor Eli Richman.